Choledocholithiasis is the presence of stones in the bile ducts. The vast majority of stones in the common bile duct originate from the gallbladder (secondary duct stone) while the primary duct stones are rare.
Symptoms
- It can be asymptomatic (should be removed unlike gallstones)
- Jaundice
- Pale stool
- Dark urine
- Itching
Signs
- Jaundice (yellowish sclera and sometimes skin)
- Scratch marks in the skin
Investigations
Blood tests will show high liver function tests (ALT, AST, ALP, T. bilirubin, D. bilirubin - especially alkaline phosphatase and bilirubin level and the level of direct bilirubin is higher than the indirect bilirubin)
Imaging Ultrasound abdomen will show dilated extra-hepatic biliary system, possibly will show gallstone and the stone in the common bile duct
necro-inflammatory - AST & ALT
Treatment
- Endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction
- from the bile duct followed by laparoscopic cholecystectomy.